title: Acute cognitive impairment in patients with multiple myeloma undergoing autologous hematopoietic stem cell transplant.
abstract: BACKGROUND
  Few studies have examined the acute effects of autologous hematopoietic stem cell transplantation (Au-HSCT) on the neuropsychological functioning of patients with multiple myeloma (MM). The prevalence of cognitive deficits after induction chemotherapy (pre-AuHSCT) was examined in patients with MM, clinically significant changes in cognitive function 1 and 3 months post-AuHSCT were determined, and patients who may be vulnerable to cognitive decline during this period were identified.
  
  
  METHODS
  A total of 53 patients with MM were recruited pre-AuHSCT. Neuropsychological tests measuring multiple cognitive domains (attention, psychomotor speed, learning/memory, language, executive function, motor function) were administered pre-AuHSCT and 1 and 3 months post-AuHSCT. A pretreatment assessment was not available. An Overall Cognitive Function Index was computed to determine cognitive impairment pre-AuHSCT, and a practice-effect-adjusted Reliable Change Index was used to determine cognitive change over time.
  
  
  RESULTS
  Overall, deficits were more frequent in learning/memory, executive function, motor function, and psychomotor speed. Before AuHSCT, 47% of patients (25/53) exhibited cognitive impairment as determined by the Overall Cognitive Function Index. One month post-AuHSCT, 49% of patients (20/41) demonstrated clinically significant decline on 1 or more measures; 3 months post-AuHSCT, 48% (14 of 29 patients) showed decline on 1 or more measures. Older patients, minorities, and those with advanced disease, more induction cycles, or postinduction deficits showed greater vulnerability to decline.
  
  
  CONCLUSIONS
  Nearly half of the patients showed vulnerability to impairment in learning/memory or executive function after receiving induction therapy, and the prevalence of impairment remained high post-AuHSCT. Awareness of cognitive impairment and associated risk factors in actively treated patients is important for considering psychosocial or other support for patients with acute cognitive symptoms.
authors.affiliation: Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Desiree
authors.initials: D
authors.lastname: Jones
authors.forename: Elisabeth G
authors.initials: EG
authors.lastname: Vichaya
authors.forename: Xin Shelley
authors.initials: XS
authors.lastname: Wang
authors.forename: Mary H
authors.initials: MH
authors.lastname: Sailors
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cleeland
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Wefel
mesh_terms: D000208:Acute Disease; D003072:Cognition Disorders / Q000209:etiology*; D056344:Executive Function / Q000502:physiology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007858:Learning / Q000502:physiology; D008137:Longitudinal Studies; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000628:therapy*; D014182:Transplantation, Autologous
keywords: MDASI; autologous transplant; cognitive impairment; induction chemotherapy; multiple myeloma; neuropsychological testing; patient-reported outcomes